Healthcare Provider Details

I. General information

NPI: 1003996307
Provider Name (Legal Business Name): LANA YAEL LOGAN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10730 W 143RD ST STE 32
ORLAND PARK IL
60462-1976
US

IV. Provider business mailing address

5844 ELAINE DR STE 103
ROCKFORD IL
61108-2494
US

V. Phone/Fax

Practice location:
  • Phone: 312-502-0118
  • Fax: 708-675-7574
Mailing address:
  • Phone: 312-502-0118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180007562
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: